The Federal Air Surgeon's Column

On April 24, 1998, Congress enacted the Aviation Medical Assistance Act, which, in part, directed the Federal Aviation Administration to determine whether current minimum requirements for air carrier crewmember medical emergency training and air carrier emergency medical equipment should be modified. At the core of the legislation was the issue of requiring automated external defibrillators (AEDs) on air carrier flights, as well as the question of enhancing current requirements regarding the contents of medical kits.

How much medical equipment should be required in air carrier operations has been a matter of controversy and debate for years. Up until December of 1986, there was no agency requirement for medical equipment or medications, other than a first-aid kit. The requirement for a medical kit was the final outcome of a petition for rulemaking submitted to the FAA in the spring of 1981 by the Research Group of the Aviation Consumer Action Project. Without going into detail of all that transpired in relationship to that petition, the agency issued a Notice of Proposed Rulemaking (NPRM) on medical kits in the spring of 1985. Contained in that Notice was the proposal that a kit include a significant number of medications and equipment to treat medical emergencies.

The proposed contents of the kit met opposition from some segments of the medical community based on concerns that, if misused, some of the equipment and medications proposed for inclusion in the kit could make matters worse for stricken passengers. This, coupled with a concern for the lack of data to support such a comprehensive kit, led to a significant reduction in the kits contents. In the final rule, much of the equipment was deleted; of the medications, only glucose, nitroglycerin, epinephrine, and diphenhydramine remained. In the years that have passed since the rule was implemented, there has been continuing public and news media interest in the sufficiency of the required medical kit, especially in light of the more extensive medical kits found on board many foreign air carriers.

The FAA has carefully assessed all the issues related to medical events that occur on board aircraft. This, coupled with data collected pursuant to the Aviation Medical Assistance Act, led the FAA to issue an NPRM on May 24, 2000, that would require all air carrier aircraft (over 7,500 lbs. payload with at least one flight attendant) to carry AEDs and an enhanced medical kit.

Requiring the placement of medications and sophisticated medical equipment such as AEDs on board aircraft may raise significant questions in the minds of many. These might include:

what are the cost/benefit issues?

what crewmember training should be required?

who would be permitted to use the equipment?

will passengers who have medical training voluntarily come forward and use the equipment?

what legal liability exists and for whom?

The list of questions could be extensive.

It is important that as many interested and knowledgeable persons as possible comment on this proposed rule. Therefore, I encourage you to read the NPRM and let your thoughts be known. Internet users may access the document on the FAAs website at http://www.faa.gov/avr/arm/n00-03.pdf.